Wednesday, November 25, 2009

Health Care

[from John - Image added by Ira] I am posting my comments as a separate Topic because my view shifts the discussion and it seems more appropriate to post it separately.

I can understand a government run MINIMAL universal health care plan, similar to Medicare, a plan that is evenly applicable to all who have paid their FAIR SHARE of the costs. I can also envision a MINIMAL universal health care plan for those citizens who are TRUELY needy including children for which I should bear my fair share of the burden, (please note my emphases).

With that said, I must return to the main principle I and most of us elderly were raised to follow - responsibility.
I wish to make my own decisions regarding my health care and if I make a mistake, I accept the responsibility as I have done on all matters throughout my life. If I, with or without my doctor’s advice, select a treatment and it is more expensive or less effective than the government’s choice or my doctor’s suggestion then so be it. I made the choice and I will bear the consequences.

I can understand Stu’s and others position. Comparative Effectiveness Research (CER) and Quality Adjusted Life Years (QALY) are necessary to a government run health care system as is the necessity that it be self-sustaining. It will also be necessary to refuse treatments that are proven ineffective. A government run health care system should not over burden society nor should it forward its burdens into the future, nor should it inequitably burden certain elements of society.

Touching on the elderly, QALY, some might say, is a form of euthanasia I disagree. First, a government’s first responsibility to toward its productive citizens, second, it is responsible to ease the effect of aging. I as a responsible citizen must be willing to accept that the government will ease my remaining years but do no more than that.

Finally, I as a responsible citizen, have the responsibility to provide for my welfare in my retirement. Some citizens will be able to provide better for themselves than others will, that is why I agree with a minimal health care system. However, how can I have free choice amongst several treatments for a medical problem while the government’s system properly says it will only pay for the least expensive, effective treatment? My suggestion is, let’s assume that there are four treatments that are effective costing, a-$1300, b-$1000, c-$1500 and d-$1700. The government, rightly, should offer treatment b. However, if I wish to choose treatment c then the government plan should pay $1000 and I should be responsible for the remaining $500. I believe this is an appropriate blend of government and individual responsibility.

10 comments:

Ira Glickstein said...

Thanks John for joining the health care discussion. We are in agreement that the government has a role, but it needs to be MINIMAL.

I appreciate your bringing up Comparative Effectiveness Research (CER) and Quality-Adjusted LIfe Years (QALY).

Few would argue with CER - we need honest brokers to evaluate alternative treatments and drugs and compare their effectiveness and determine if their cost is proportional to the benefit.

As you say, "Touching on the elderly, QALY, some might say, is a form of euthanasia I disagree." I agree with you and disagree with those (including Sarah Palin who I otherwise greatly respect) who call these ideas "death panels" or "pulling the plug on granny" or "rationing". In the narrowest interpretation of those words, they are correct. QALY-based limits on reimbursement will hasten the deaths of some who are already on the down-slope of end of life, will prevent "granny" from getting expensive care that a younger, more healthy person would get, and will therefore ration expensive health care. However, in a broader interpretation, as you say, "First, a government’s first responsibility to toward its productive citizens, second, it is responsible to ease the effect of aging." Given that government-funded health care is a limited resource, sometimes we must accept palliative care as more appropriate for the terminally ill, sometimes we must not hook "granny" up to a machine that will merely prolong the death process, sometimes we must allocate resources in the most productive and effective way.

Ira Glickstein

Stu Denenberg said...

I agree with John's points --- mostly. I especially like his "upgrade" plan for health care, like on the airlines where, for an additional fee, you can improve your seat/service.

I do have some trouble with this part tho':

"I can also envision a MINIMAL universal health care plan for those citizens who are TRUELY needy including children"

Here's why: from a purely pragmatic view, how much will it cost to determine who is "TRUELY needy"? If it costs more to administer than the money it saves, well then...(in any case, it will be much harder to determine "true neediness" that we think.

Also how about children of unwed mothers and welfare queens --- should I have to shoulder their burden? Well, yes, I think I do because I personally believe that compassion trumps morality or at least rightousness. Universal Health Care may be a copout from the point of view of strict moral decision making but it seems to me to be the more compassionate choice. We all seem to agree that our armed forces, police and firemen protect all of our citizens and not just the "deserving"; why is provision of health care less important than providing security?

Stu

JohnS said...

I see nowhere in the constitution that our government is obligated to extend my life for ever and ever and I am of the age where it may be only a few years before my time comes.

Ira Glickstein said...

John and Stu: There is a fine line between pure "compassion" and decsions that lead to "moral hazards".

Yes, I feel compassion for the totally innocent children of "unwed mothers and welfare queens" (Stu's words). We, as a society, need to provide for them. I even feel compassion for the mothers. Their bad childhoods and mental/physical handicaps inevitably brought them down. We are all, more or less, victims or beneficiaries of the accident of our birth - "There, for the Grace of God, go I!"

On the other hand, if we give equal rewards to those who have made bad decisions, we will end up with a multi-generational dependent welfare society. That is called a "moral hazard" (as was the decision to rescue corporations that acted irresponsibly.) If reckless decisions do not have dire consequences, we encourage future bad behavior. Societies come and go over the centuries. Moral hazards take their toll.

John says "I see nowhere in the constitution that our government is obligated to extend my life for ever and ever ..." Well, there is the clause about "promote the general welfare" that could be interpreted, by an over-liberal Supreme Court, as just such an obligation. I know people who are deeply offended when any American dies for lack of medical care because they cannot afford it, while others with the identical ailment pay and live, and still others get expensive cosmetic surgery for themselves (and their dogs and cats :^)

Those with literal believe in a caring God console themselves with the knowledge eveything will be sorted out in the afterlife. Those without such belief can only fall back on Darwinian evolution where only the fittest survive and reproduce. For me, that is Nature's Law and we have no choice but to live or die by it.

Ira Glickstein

Howard Pattee said...

I agree with Stu that compassion trumps morality. In other words, compassionate assistance can aid society whether or not the causes of suffering are misfortune or immoral behavior. My preacher father–in-law always said that church is for sinners.

Ira says, “Those without such belief [in God] can only fall back on Darwinian evolution where only the fittest survive and reproduce. For me, that is Nature's Law and we have no choice but to live or die by it.”

This 19th century view of individual fitness does not hold for social groups. This conservative tough-on-crime philosophy has incarcerated the highest proportion of sinners in American prisons than any other country at enormous cost. I don’t believe this makes us the fittest society, only the most wasteful.

Stu Denenberg said...

Ira said:

"On the other hand, if we give equal rewards to those who have made bad decisions, we will end up with a multi-generational dependent welfare society. That is called a "moral hazard" (as was the decision to rescue corporations that acted irresponsibly.) If reckless decisions do not have dire consequences, we encourage future bad behavior. Societies come and go over the centuries. Moral hazards take their toll."

I can't say exactly why but the term "moral hazard" bothers me. So I googled " arguments against "moral hazard"" and didn't find anything useful yet but I wanted to share this link: http://pseudoconservativewatch.blogspot.com/2007/01/why-is-moral-hazard-problem-for-less.html

I'm sure that Ira does not deserve the criticism that this guy makes but I'm also sure that there are others that do and it is something to think about.

Stu

Ira Glickstein said...

Thanks Stu for your link, here in clickable form.

The writer, who calls himself "James Bond" (perhaps his real name?) looks a bit like you, but is far more muddle-minded. (That was a backhanded complement to you :^)

His initial definition of "moral hazard" is fine, but then he equates it to fire insurance, because some unscrupulous businessmen may set fire to their failing businesses to get well financially.

Yes, there are arsonists, and they go to jail when caught. Insurance is void in case of non-accidental fires.

The whole point of insurance is to spread the risk of "acts of God". Rates are based on the level of risk in a given industry and geographic location. The insured are required to reduce risks with good housekeeping and to install smoke detectors to minimize damage. Businesses with a history of major claims face increased premiums or are dropped altogether. All the payouts come from similarly situated insured, minus deductables and administration fees to investigate claims fraud.

The bailouts of major corporations that failed due to their own reckless risk-taking is a "moral hazard" because those losses were not accidental. Taxpayer money comes from responsible people who work hard and busineses that provide products and services customers voluntarilly pay for. If you subsizize irresponsibility, you'll get more of it!

Nationalized health insurance does not allow higher premiums for those with self-inflicted illness (smoking, obesity, drinking). That is like requiring a fire insurance company to give insurance to a guy whose business in already on fire!

It is a "moral hazard" to buy health insurance for those who were too lazy to study in (free public) school and therefore are unemployed or have low-paying jobs. Yes, we need to provide a reasonable level of care for their children, and some minimum level for them.

Your "James Bond" goes on to equate limited liability corporations and bankruptsy laws and worker's compensation with "moral hazards". Again, these cover only unexpected losses. Penalties are imposed against businesses with unsafe working conditions that injure employees. Entrepreneurs and individuals who go bankrupt find it difficult to get future loans. In each case, bad behaviors are punished.

Ira Glickstein

Stu Denenberg said...

I especially liked and agree with Ira's comment, "If you subsidize irresponsibility, you'll get more of it!" This is textbook behavioral modification theory where you reward the desired behavior and ignore the undesired ones.

I am surprised that Ira did not refute the main point of the article which claims that conservatives only apply the moral hazard argument to the poor working folk and not to the "fat cats". Clearly Ira is a conservative and clearly he condemns those who voted to subsidize the wall street companies who caused the mess in the first place. This is why, as one of few lonely liberals on the blog, I continue to contribute (albeit sporadically). It's a clean, well-lighted space where "respectful" discourse can (and often does) occur.

Stu

Ira Glickstein said...

Thanks Stu for your kind comments. I love having you and Howard -"lonely liberals"- on the Blog and wish you guys would attract even more thoughtful diversity to our "respectful discourse". All too many Blogs seem to be nothing but "flaming".

Indeed, I try to apply the "moral hazard" standard to both fat cats and alley cats equally. I'm currently a third of the way thru Sarah Palin's Going Rogue and have a much better understanding of how Big Oil colluded with both the establishment Republicans and Democrats in Alaska. Exxon-Mobil, BP and VECO had dangerous environmental practices. In addition, they were sitting on their oil leases, cheating the owners of the mineral resources (the citizens of Alaska) out of their fair share. As a populist, whose Dad imposed a mighty work ethic on her, she was outraged by the "moral hazard". She did not know it was impossible, so she went ahead full steam and, as a result of her initiatives (and the FBI's) several of the malefactors -mostly Republicans- are out on their asses and some are wearing prison jump suits.

Ira Glickstein

Ira Glickstein said...

Thanks Stu for your kind comments. I love having you and Howard -"lonely liberals"- on the Blog and wish you guys would attract even more thoughtful diversity to our "respectful discourse". All too many Blogs seem to be nothing but "flaming".

Indeed, I try to apply the "moral hazard" standard to both fat cats and alley cats equally. I'm currently a third of the way thru Sarah Palin's Going Rogue and have a much better understanding of how Big Oil colluded with both the establishment Republicans and Democrats in Alaska. Exxon-Mobil, BP and VECO had dangerous environmental practices. In addition, they were sitting on their oil leases, cheating the owners of the mineral resources (the citizens of Alaska) out of their fair share. As a populist, whose Dad imposed a mighty work ethic on her, she was outraged by the "moral hazard". She did not know it was impossible, so she went ahead full steam and, as a result of her initiatives (and the FBI's) several of the malefactors -mostly Republicans- are out on their asses and some are wearing prison jump suits.

Ira Glickstein